FCC Singing Valentine Order Form
A "Singing Valentine" ($45) includes a Love Song, a fresh red rose, some kisses (Hershey’s that is), and a special custom card. Each additional rose/card combo is $5.00. Special specific time requests adds $20.00.

Preliminary question - have you ever heard of the Fun Center Chordsmen? *
Valentine Recipient Name *
First Name Last Name
Your answer
Please provide performance location type. *
Performance Address *
What street address will the quartet be traveling to for this performance? Enter "N/A" if a phone SV.
Your answer
Performance City *
What city will the quartet be traveling to for this performance? Enter "N/A" if a phone SV.
Your answer
Performance Zip Code *
Zip Code of Performance Site. Enter "N/A" if a phone SV.
Your answer
How to contact the gift giver/purchaser *
Choose one below.
Contact Number *
xxx-xxx-xxxx / number associated with previous question
Your answer
If a "Phone" Valentine, what number should we call the recipient at?
Your answer
How did you know about this online form? *
Can we credit this order/sale to a specific Chordsmen? If so, what is the first and last name of the Chordsmen you'd like to apply this order to?
Your answer
Would you like to receive future information related to Chordsmen activities, delivered via email? Can provide email address later in this order form. *
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